Welcome to another edition of Baby Medical Q&A News.
Constipation in Toddlers
Constipation is so common in toddlers and is a frequent cause of tummy pain.
The reason toddlers get constipated is relatively simple:
- they pass a hard stool (poop, poo) and it hurts - the stool may be hard because your toddler has been unwell with a cold and not eating so well and also he may have been less active than normal OR there could have been a change in diet for some reason. Sometimes we just have harder stools (poop, poo) that usual
- a toddler who has a painful poop will think "I'm not doing that again". You and I know, of course, that the worst thing you can do if you are slightly constipated is to not go, but toddlers don't think like that. They are programmed to avoid pain - which is great if they touch a hotplate because you don't want them to repeat that, but it doesn't work if the poop is hard. In that case, they need to keep going to the toilet but they don't know that
- the "danger time" for toddlers getting constipated is usually once they are toilet trained and going alone, so you as the parent are not necessarily aware of what the stool (poop, poo) looks like. Maybe you think your child is going to the toilet and he tells you he has been but he may have only passed a pebble sized poop and that isn't enough to be normal
- when toddlers withhold stool (poop, poo) because it hurts to pass it, the bowel just stretches and accommodates this. However, stretching of the bowel causes pain, so children will often complain that their tummy hurts
So, if your toddler is constipated what do you need to do is soften the stools (poop,poo). This can be by changing the diet, but even children who eat lots of fruit and vegetables can become constipated, so sometimes laxatives are needed. You can read more about constipation remedies, including natural ones but clicking here.
The next commonest mistake I see in management of constipation where laxatives are necessary is that they are stopped too soon or the dose is not adjusted, so here are my top tips for making sure you get it right:
- first, understand that it often takes time for the constipation to show itself - your toddler may have been withholding stool for months before you realise it is a problem. It could therefore take nearly as long to get things back on track. Too many parents stop the laxatives too early and the problem just recurs
- as doctors we know approximate doses for different aged children but every child is different, so the initial dose you are given will be a guess (albeit an educated guess). The important thing is that the dose is adjusted to get the desired result - this may mean you have to do the adjusting as you are there to check what the poop looks like. Ideally we want a soft but formed (so sausage shape) poop every day. If the poop is less frequent than that or is hard like rocks, then more laxative is needed. If the poop is too soft or too frequent, then less laxative is needed. To read more about adjusting the dose of laxative, click here
- you need to gradually wean the laxative dose down over time. Eventually, you may only need the occasional dose if your child has missed a day going or if you notice the poop looking hard and being less like a sausage and more like a ball (which I call rocks as they are often hard and children get what I mean)
- understand that laxatives will not harm the bowel if they are needed. Not having laxatives and letting poop build up and stretch the bowel is likely to be worse for the body. As time goes on, you may get the desired result with fruit and vegetable and that's great
- I don't favor the use of suppositories for children who are constipated. As a general rule, I don't think it helps a child to lose their fear of passing hard stools by putting suppositories in their bottom. So, my advice is to use these with caution and as a last resort
One last important point.
Make sure your child is comfortable on the toilet
- have a foot stool so he can sit with his feet firmly on something, rather than dangle
- make sure he sits with his knees above the level of his chest
- have your toddler lean forward putting his hands on his knees - this will give a straight back
- try getting your toddler to blow a balloon - this will increase intra-abdominal pressure and aid pooping
To read more on constipation, click here
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Till next time,
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